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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by B2chica on January 27, 2012, at 10:30:05
sorry bout spelling on those but what do you folks think would be my best solution.
i obviously still have issues iwth depression.
i dont want to gain tons of weight.i've never had luck with mood stabilizers but was only on lamictal for about a week (while inhospital) so not really sure of its effects.
currently on
pristiq
perphenazine
adderall
gabapentin
xanax
b2c.
Posted by Velthir on January 27, 2012, at 11:13:13
In reply to lamictal or nortriptaline, posted by B2chica on January 27, 2012, at 10:30:05
> sorry bout spelling on those but what do you folks think would be my best solution.
> i obviously still have issues iwth depression.
> i dont want to gain tons of weight.
>
> i've never had luck with mood stabilizers but was only on lamictal for about a week (while inhospital) so not really sure of its effects.
>
> currently on
> pristiq
> perphenazine
> adderall
> gabapentin
> xanax
>
>
> b2c.To give Lamictal a real chance you'd have to be on it long enough to titrate up to 100-200mg (which takes several weeks) and then give it a few weeks at the target dose.
Nortriptyline worked well for me for depression/sleep for a while, before it pooped out (every AD seems to stop working for me after a while). Provided the perfect amount of sedation with no hangover, very few side effects. I didn't get any weight gain with it, for what it's worth. But then I've not really had weight gain with any psych med as of yet (except maybe Remeron).
No idea which would work better for you though. Lamictal is more weight neutral and probably has less side effects in general (you'll probably get dry mouth and some constipation to start with on Nortriptyline).
Posted by Phillipa on January 27, 2012, at 11:54:37
In reply to Re: lamictal or nortriptaline, posted by Velthir on January 27, 2012, at 11:13:13
I'd try lamictal also. I was once on it and only side effect was intractible saliva and spitting it out constantly. Was a rare side effect. other than that was fine just titrate slowly. Phillipa
Posted by B2chica on January 27, 2012, at 12:58:38
In reply to Re: lamictal or nortriptaline, posted by Velthir on January 27, 2012, at 11:13:13
i just have a bad history with mood stabilizers, they seem to give me bipolar symptoms with mood going up and down.
im afraid the lamictal will do the same.
Posted by Dinah on January 27, 2012, at 13:11:35
In reply to lamictal or nortriptaline, posted by B2chica on January 27, 2012, at 10:30:05
Nortryptaline was awful for me. As awful as Effexor and Wellbutrin. If you're prone to anxiety or agitation, I'd be cautious.
Posted by B2chica on January 27, 2012, at 15:06:52
In reply to Re: lamictal or nortriptaline, posted by Velthir on January 27, 2012, at 11:13:13
sounds like me. most ssri's poop out for me after a while or just plain dont work.
may i ask what you are currently on?
is it successful?i was successfully on pristiq, it seems until this bout of bronchitis,i was on zpac for a while and off adderall for a couple days and it seems like i cant get back to normal from there.
Posted by bleauberry on January 28, 2012, at 8:09:32
In reply to lamictal or nortriptaline, posted by B2chica on January 27, 2012, at 10:30:05
It is going to be very difficult for any med to break through the clutter of all the other meds in the cocktail. And if you are still depressed, then obviously the current meds need to be re-examined. I personally do not see any sense in taking meds that don't work, but that's just me.
If you are determined to keep the current cocktail going for whatever reason and add something else to it, then of the choices you listed I would go with Nortriptyline. I doubt seriously lamictal will offer anything except more side effects and problems. Nortriptyline at least has a decent chance of synergizing well with pristiq.....pristiq is almost pure serotonon, while nortriptyline would take care of the norepinephrine side of things, a nice blanket strategy that you currently do not have in place.
For people who do get better on nortriptyline, it is not unusual to see it still working years later. Lamictal is a different story. In clinical studies it was good only up to 9 months max (if it worked at all). The summary claim for it is something like this, 'delays but does not prevent future depressive episodes'. Personally, find someone who can say lamictal has been wonderful and is still working great after 3 years, and I will drop my jaw. I'm sure it must happen, I've just never seen it here in over 10 years and that to me is a fairly decent yardstick.
Posted by polarbear206 on January 28, 2012, at 9:26:06
In reply to Re: lamictal or nortriptaline, posted by bleauberry on January 28, 2012, at 8:09:32
> It is going to be very difficult for any med to break through the clutter of all the other meds in the cocktail. And if you are still depressed, then obviously the current meds need to be re-examined. I personally do not see any sense in taking meds that don't work, but that's just me.
>
> If you are determined to keep the current cocktail going for whatever reason and add something else to it, then of the choices you listed I would go with Nortriptyline. I doubt seriously lamictal will offer anything except more side effects and problems. Nortriptyline at least has a decent chance of synergizing well with pristiq.....pristiq is almost pure serotonon, while nortriptyline would take care of the norepinephrine side of things, a nice blanket strategy that you currently do not have in place.
>
> For people who do get better on nortriptyline, it is not unusual to see it still working years later. Lamictal is a different story. In clinical studies it was good only up to 9 months max (if it worked at all). The summary claim for it is something like this, 'delays but does not prevent future depressive episodes'. Personally, find someone who can say lamictal has been wonderful and is still working great after 3 years, and I will drop my jaw. I'm sure it must happen, I've just never seen it here in over 10 years and that to me is a fairly decent yardstick.
You will find an overwhelming positive reviews for Lamictal on many sites including revolution health. Do your own research and come to your own conclusion. Lamictal gave me my life back (jaws drop) and I've been on it for over 12 years. Good luck.
Posted by bleauberry on January 28, 2012, at 10:17:10
In reply to lamictal or nortriptaline, posted by B2chica on January 27, 2012, at 10:30:05
Lamictal does not get overwhelming response at other sites. For that you would need to look at Nardil, Parnate, and Tramadol. Those are the ones that get the highest marks on a 1 -5 average. Lamictal is in the low 3's along with just about everything else, the three meds I mentioned are in the 4's.
Lamictal does work miracles sometimes. It's just that the usual pattern is the miracle does not have endurance most of the time. The TCAs and MAOIs have demonstrated a more reliable endurance record over the years I believe.
If I had seizures I would probably consider lamictal because that's what it is actually supposed to be for....slowing down and controlling excess brain activity. That's probably why word recall and such are common problems with many folks at therapuetic doses. Lamictal for depression was an add-on marketing strategy because they needed to figure out another way to generate more income from it and tap into the huge depression market which is obviously much more profitable than the seizure market.
Honestly, Advil improved my depression more than lamictal. I did have about 2 weeks of miracle recovery when I started lamictal. It was unbelievable. Amazing. Two weeks later it was mostly gone, replaced with sort of a flatline emotion, and doses up to 200mg didn't bring back the goodness.
Therapeutic dose is the lowest dose that works. I've seen that to be as low as 25mg to as high as 400mg. It depends on the person.
There are exceptions to every rule in psychiatry and the phrase mileage varies rules the game. I'm just sayin, if the choice for me is nortriptyline or lamictal, my choice is nortriptyline.
It's not an either/or dilemma. If your first choice doesn't work out, go to the second. When you get right down to it, it really doesn't matter what anyone on this forum says, or other forums, or clinical studies, or anything....there is no way to predict which of these two meds, if any, is right for you or not. Since it is a guessing game, I just happen to think nortriptyline has better odds than lamictal for a variety of reasons.
Posted by polarbear206 on January 28, 2012, at 12:19:44
In reply to Re: lamictal or nortriptaline, posted by bleauberry on January 28, 2012, at 10:17:10
Just to clarify....I am refering to lamictal used as a conjunctive to an AD and specifically in cyclic mood disorders.
Revolution health ratings. FYI
Bipolar nos 7.9
Bipolar l 7.1
Bipolar ll 7.1
BPD 8.2Total average of 7.5
I'd say that's a pretty good track record in comparrison to other mood stabilizers with nasty side effects.I think tricyclics are great drugs, however, they will induce cycling in mood disorders. Been there done that......Maoi's are great for atypical depression and Bipolar in combo with
a mood stabilizers. pubmed.gov has tons of research and psycheducation.orgSorry blueberry, but lets just agree to disagree.
Effexor/lamictal/clonopin-as needed.
Posted by phidippus on January 28, 2012, at 16:20:56
In reply to lamictal or nortriptaline, posted by B2chica on January 27, 2012, at 10:30:05
I would trade your perphenazine for Seroquel. Seroquel has a lot of data supporting its efficacy in treating depression.
Eric
Posted by polarbear206 on January 28, 2012, at 16:26:02
In reply to Re: lamictal or nortriptaline, posted by polarbear206 on January 28, 2012, at 12:19:44
> Just to clarify....I am refering to lamictal used as a conjunctive to an AD and specifically in cyclic mood disorders.
>
> Revolution health ratings. FYI
>
> Bipolar nos 7.9
> Bipolar l 7.1
> Bipolar ll 7.1
> BPD 8.2
>
> Total average of 7.5
> I'd say that's a pretty good track record in comparrison to other mood stabilizers with nasty side effects.
>
>
>
> I think tricyclics are great drugs, however, they will induce cycling in mood disorders. Been there done that......Maoi's are great for atypical depression and Bipolar in combo with
> a mood stabilizers. pubmed.gov has tons of research and psycheducation.org
>
> Sorry blueberry, but lets just agree to disagree.
>
> Effexor/lamictal/clonopin-as needed.
>
Fyi-Lamictal effectivness drug reviews for bipolar,etc...Drugs.com 8.6 / 10
Webmd.com 3.7 / 5
Psychecentral 3.9 / 5
Druglib.com 8.35 / 10
Drugratings.com 4.0 / 5.0Many more....also......
crazymeds has a page with sources for lamictal drug reviews
Posted by polarbear206 on January 28, 2012, at 16:52:13
In reply to Re: lamictal or nortriptaline))))))blueberry, posted by polarbear206 on January 28, 2012, at 16:26:02
pubmed.gov. You will find over 1,000 research and clinical studies on the use of Lamictal. Here is a small sample.
Evidence of treatment for depressive episode of bipolar disorder
Clinical management of bipolar review of evidence based guidelines.
Medical treatment of bipolar disorder summary of expert consensus
Posted by bleauberry on January 29, 2012, at 7:58:31
In reply to Re: lamictal or nortriptaline, posted by polarbear206 on January 28, 2012, at 12:19:44
"Sorry blueberry, but lets just agree to disagree."
Agreed with a smile. Hey, if you think about it, the entire world of psychiatry is all about agree to disagree. What I mean by that is if you go to 10 different doctors, there will be multiple diagnosis varying from one to another and there will be multiple preferred strategies to deal with it. None are right. None are wrong. The prognosis is purely unknown, the actual disease unknown, and the actual fix an educated guess. So obviously when the landscape looks like that there will be a lot of agree to disagree becaause no one really knows.
Posted by B2chica on January 30, 2012, at 7:56:15
In reply to Re: lamictal or nortriptaline » B2chica, posted by phidippus on January 28, 2012, at 16:20:56
been on seroquel. best sleep of my life...for a while.
gave me cognitive blunting. dumb as a stump.thanks for advice.
i still haven't heard from pdoc. thought he was going to try to get me in sooner but i guess i'll have to wait till next friday.
feels like a lifetime away.
Posted by Phillipa on January 30, 2012, at 18:40:54
In reply to Re: lamictal or nortriptaline » phidippus, posted by B2chica on January 30, 2012, at 7:56:15
You sound a lot better. Phillipa
Posted by b2chica on February 1, 2012, at 17:27:31
In reply to Re: lamictal or nortriptaline » B2chica, posted by Phillipa on January 30, 2012, at 18:40:54
This is the end of the thread.
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